MEDICARE: DR. SANDRA J DIRKS PHARMD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	16559	IA
2	1835P1200X	Pharmacotherapy Pharmacist	16559	IA
3	1835P1300X	Psychiatric Pharmacist	16559	IA

General Provider Information

NPI Number	:	1083619738
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SANDRA J DIRKS PHARMD

Provider Business Mailing Address
First Line	:	383 SW KENNYBROOK DR
Second Line	:
City	:	GRIMES
State	:	IA
Zip	:	50111-1044
Country	:	US
Telephone Number	:	515-282-2245
Fax Number	:

Provider Business Practice Location Address
First Line	:	2507 UNIVERSITY AVE
Second Line	:
City	:	DES MOINES
State	:	IA
Zip	:	50311-4516
Country	:	US
Telephone Number	:	515-282-2245
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/18/2005
Last Update Date	:	09/11/2025

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